National Strategic Plan for Neglected Tropical Diseases

Home , Andara, Karasburg, Mpungu, Okahao, Okakarara, Oniipa

MINISTRY OF HEALTH AND SOCIAL SERVICES

2015 - 2020

Stark, Sophie, Haikera

2015 January

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Introduction

Namibia is one of the countries in Africa where communicable diseases are diseases of public health importance and the leading causes of morbidity and mortality. The Government of the Republic of Namibia through the Ministry of Health and Social Services has been addressing the major communicable diseases such as malaria, HIV/AIDS, TB, ARI, epidemic prone diseases, Diarrheal disease and other diseases of public health concern with the support of national and international partners and involvement of the community. As a result of this, the country has shown tremendous progress in controlling and decreasing their incidences and prevalence. Moreover, it has reduced malaria morbidity & mortality, HIV prevalence, TB incidence, and infant and child mortality rates.

However, some neglected tropical diseases (NTDs), despite being diseases of public importance with known and available preventive and control measures have not received enough attention and concerted efforts as bestowed to the major ones.

Understanding the morbidity caused by these diseases and its implication for achieving the MDGs the Ministry of and Social Services has established the Epidemiology Division within the Primary Health Care. The division main aim is to control morbidity and mortality due any communicable diseases of public health interest including Schistosomiasis, Soil Transmitted Helminthes to a level where they are no longer diseases of public health importance. The Ministry of Health and Social Services is also in a process to establish a Public Health laboratory in order to strengthen diagnostic and surveillance capacity and eventually contribute to improved response in the country.

Though partial mapping was done for some of the PCT-NTDs, the epidemiology and distribution of NTDs in Namibia is still unknown. As the burden and occurrence of the NTDs can be minimized with safe and effective prevention and treatment strategies such as preventive chemotherapy and vector control, for an effective intervention, understanding their distribution is of paramount importance since mapping is the first step that determines the distribution of NTDs prior to interventions.

Part 1: Situation analysis

1.1 Country Profile

1.1.1 Administrative, demographic and community structures

On March 21, 1990 Namibia achieved its independence after a century of colonial rule, first by Germany and then by South Africa, following the successful implementation of United Nations Resolution 435. With a constitution based on Roman-Dutch law, the country has a multi-party system and holds general elections every five years. A bicameral legislature consists of the National Council (two members chosen from each regional council) and the National Assembly. Administratively, the country is divided into 13 regions, namely: Zambezi, Kavango east, Kavango West, Kunene, Ohangwena, Omusati, Oshana, and Oshikoto regions in the north; Omaheke, Otjozondjupa, Erongo, and Khomas regions in the central areas; and the Hardap and Karas regions in the south.

According to the 2001 Population and Housing Census, the Namibian population consists of 1,830,330 people, of which 942,572 are female and 887,721, are male (Table 1.1). The country has a relatively young population, with 43 percent under 15 years of age and less than 4 percent over age 65. Despite rapid urbanization, Namibia is still mainly rural, with one in three living in urban areas. Overall, the population density is low (2 persons per square kilometer). Regional population densities vary substantially, with almost two-thirds of the population living in the four northern regions and less than one-tenth living in the south. Despite its small population, Namibia has a rich diversity of ethnic groups. English is the official language but there are more than 11 indigenous languages in Namibia.

Table1. National population data, Schools and health facilities at district level Province or District No. of Total Under 5-14 No. of No. of region villages or population fives years primary peripheral communities schools health facilities * Caprivi Katima Mulilo 100,528 14,074 23,121 32 Erongo Omaruru 19,415 2,718 4,465 6 Erongo Swakopmund 42,590 5,963 9,796 14

Erongo Usakos 16,499 2,310 3,795 9 Erongo Walvis Bay 54,897 7,686 12,626 20 Hardap Aranos 11,337 1,587 2,608 3

Hardap Mariental 39,203 5,488 9,017 9 Hardap Rehoboth 33,576 4,701 7,723 10 Karas Karasburg 19,071 2,670 4,386 6

Karas Keetmanshoop 38,465 5,385 8,847 10 Karas Luderitz 27,324 3,825 6,285 12 Kavango Andara 37,047 5,187 8,521 10

Kavango Nankudu 62,471 8,746 14,368 13 Kavango Nyangana 34,041 4,766 7,829 11 Kavango Rundu 147,680 20,675 33,966 26

Khomas Windhoek 316,508 44,311 72,797 41 Kunene Khorixas 17,400 2,436 4,002 9 Kunene Opuwo 54,768 7,668 12,597 16

Kunene Outjo 19,264 2,697 4,431 4 Ohangwena Eenhana 84,382 11,813 19,408 12 Ohangwena Engela 196,126 27,458 45,109 19

Ohangwena Okongo 28,052 3,927 6,452 5 Omaheke Gobabis 95,010 13,301 21,852 16 Omusati Okahao 35,511 4,972 8,168 11

Omusati Oshikuku 124,673 17,454 28,675 19 Omusati Outapi 83,320 11,665 19,164 13 Omusati Tsandi 45,610 6,385 10,490 11

Oshana Oshakati 211,031 29,544 48,537 21 Oshikoto Onandjokwe 186,393 26,095 42,870 18 Oshikoto Tsumeb 30,465 4,265 7,007 7

Otjozondjupa Grootfontein 51,256 7,176 11,789 9 Otjozondjupa Okahandja 35,527 4,974 8,171 4 Otjozondjupa Okakarara 29,411 4,117 6,764 7

Otjozondjupa Otjiwarongo 73,799 10,332 16,974 9

1.1.2 Geographical characteristics

Namibia is situated in South-Western Africa and covers approximately 824,000 square kilometers. It is bordered by the Atlantic Ocean in the west, Botswana and Zimbabwe in the east, South Africa in the south, and Angola and Zambia in the north. The Namib Desert, the oldest desert in the world, stretches along the whole west coast of the country,

while the Kalahari Desert runs along the southeastern border with Botswana. Namibia’s name is derived from the Namib Desert, a unique geological feature renowned for the pristine and haunting quality of its landscape. The Namibian climate varies from arid and semi-arid to subtropical with temperatures between 5°C and 20°C. Fog sometimes occurs along the temperate desert coast. The central, southern, and coastal areas constitute some of the most arid landscapes south of the Sahara.

The hottest months of the year are January and February, with average daytime temperatures varying between 9°C and 30°C. During the winter months, May to September, temperatures can fluctuate between -6°C and 10°C at night to 20°C in the day. Frost occurs over large areas of the country during winter, but in general, winter days are clear, cloudless and sunny. Overall, Namibia is a summer rainfall area with limited showers beginning in October and continuing until April.

1.1.3 Socio economic status and indicators The positive global economic performance between 2002 and 2006 had a favorable impact on the Namibian economy mainly through high commodity prices and strong demand from the rest of the world. In real terms, the economy recorded a growth rate of 6 percent in 2004, above the 4.4 percent projected earlier. On average, the economy grew by 4.6 percent between 2001 and 2004, just above the target rate of 4.3 percent set in National Development Plan 2 (NDP2). Taking into account the prospects of the world economy and that of Namibia’s main trading partners, the outlook for the Namibian economy for the coming years points to moderate economic performance with a projected average annual growth rate of 3.7 percent (Ministry of Finance, 2007).

The economy of Namibia, which was formerly based on natural resources, is slowly becoming more diversified. This change is partly a result of the increased processing of minerals such as diamonds, zinc, copper, and marble. In addition, tourism sector has been expanding very rapidly in the past decade, e.g., preliminary amounts indicate that travel and tourism’s contribution to GDP increased by 9.3 percent (real growth) in 2007 alone. Agricultural growth has a disproportionate effect on reducing poverty because 70 percent of the poor in developing countries, including Namibia, live in rural areas. Namibia, along with its developing-country partners, has long championed the reduction of trade barriers for agricultural products as one of the most important actions to reduce poverty.

The manufacturing sector in Namibia remains small, with fish and meat processing being the largest individual sub-sectors. Beverages, other food products, metal and

5 pre-cast concrete products, furniture, paints, detergents, and leather goods are also produced. Namibia is ranked as a middle-income country but has one of the most skewed incomes per capita in the world. The disparities in per capita income among the population are as a result of lopsided development, which characterized the Namibian economy in the past. The country also has a high unemployment rate, which is estimated at 37 percent (Ministry of Labour and Social Welfare, 2004).

1.1.4 Transportation and communication

The Namibian transport system is extensive and reaches most parts of the country by road, rail, or air. The main North-South axis by road connects the central parts of Namibia including the capital Windhoek with the South African border in the South and the Angolan border in the North. The West-East direction is covered by the road links Walvis Bay - Windhoek - Botswana border at Buitepos (Trans-Kalahari Highway), Keetmanshoop - Lüderitz and Grootfontein - Caprivi (Trans-Caprivi Highway). The railway network covers 2 380 km connecting Windhoek and Gobabis with Tsumeb/Grootfontein/Outjo, Walvis Bay, Lüderitz, and RSA via Ariamsvlei in the South. Namibia’s international airport is Hosea Kutako, other national airports includes Eros, Walvisbay, Rundu, Katima, Ondangwa, Luderitz and Keetmanshop.

In general, Namibia has good telephone, mobile and Internet coverage. Since 1996, Namibia has had access to the Internet, and digital connectivity now extends to all but the remotest areas. Mobile phone subscriptions amount to 70 phones per 100 persons, which in combination with fixed-lines amount to a total teledensity of 80%. A fiber-optic cable connects Namibia (international country code +264) to South Africa, and since 2012 it also connects to Botswana and other neighboring countries. The South African Far East (SAFE) is connected to Namibia via a submarine cable through South Africa; satellite earth stations and 4 Intelsat (2008).

Several Internet service providers currently offer broadband connectivity; in 2011, the fibre optic West African Cable System (WACS) landed on the west coast of Namibia, and with a national fiber optic backbone in place, there is immense potential for a nationwide surge in Internet usage, and consequently in eLearning activities. However, the relatively high cost of Internet connectivity in Namibia continues to constrain progress in this regard with hope for better rates in the near future.

Among the goals outlined in Namibia’s Vision 2030 is the development of a knowledge-based society, which is built upon the information and communication technology (ICT) revolution underway throughout the world, the key target being the ICT sector becoming “the most important economic sector in Namibia” by 2030.

1.2 Health system situation analyses

1.2.1 Health system goal and priorities

Goal Health and social well-being are fundamental human rights. Consequently, the ultimate goal of the Government of Namibia and the Ministry of Health and Social Services is the attainment of a level of health and social well-being by all Namibians, which will enable them to lead economically and socially productive lives.

This will be achieved through using a cost-effective developmental social welfare and Primary Health Care approach, which includes promotive, preventive, curative and rehabilitative services in collaboration with other sectors, communities, individuals and partners

Priorities set by the sector are thus guided by prevailing diseases incidences, and also the related public health importance they have to the people’s health and the economy at large. Namibia’s top ten health problems includes HIV/AIDS, stroke, coronary heart disease, influenza, pneumonia, diabetes mellitus, road traffic accidents, Hypertension, diarrheal diseases and tuberculosis

1.2.2 Analysis of the overall health system

Service delivery: Namibia has a pluralistic health system with the public sector as the main actor. The private sector plays a substantial role divided up among for-profit and not-for-profit health services. The private sector is sizeable, in particular there are 844 private health facilities registered with MOHSS, among which are 13 hospitals, 75 clinics and 8 health centers, mainly in urban areas of Erongo and Khomas regions. Seventy-two percent of doctors in Namibia are in the private sector and a little less than 50% of the registered nurses. Faith-based organizations operate services on an outsourcing basis.

MoHSS is the main implementer and provider of public health services with a four tier system: outreach points (1150) clinics and health centre’s (309), district hospitals (29) and intermediate and referral hospitals (4). Access to service is hampered by the vastness of the country with most of the country being thinly populated outside urban centers in the middle and the south of the country. Sixty percent of the population is concentrated in the north, where there is a concentration of health facilities. It is estimated that 21% of the population is living more than 10 km away from a health facility. The public health system is a unitary system managed by the MoHSS. The 13 regions have RMTs, who are responsible for the translation, implementation and management of the health system in the respective regions including the hospitals.

The Regional Director is a member of the Regional Development Committee assuring coordination between the Regional Council and the MoHSS. The Regional Council is responsible for environmental health in the regions although there is also MoHSS environmental health staff deployed in the regions. The health district has management responsibility coordinated by the DCC. In the health district, a range of PHC programme services are delivered at outreach, clinic, health centre level and to some extent at hospital level. General outpatient screening is a feature of the services with treatment of common ailments and referral of more complicated cases. Health in the community has been depending on volunteer health workers. The system has been reviewed (2006) and it was found that the system is not sustainable due to attrition of volunteer health workers.

Traditional medicine is widely used in the country and often the first port of call. However, there is no regulation of the practice. Further, more can be done to appreciate the contribution of traditional medicine.

Laboratory services are organized in the National Institute of Pathology (NIP), an autonomous entity with a mandate to provide laboratory services to the public health system and to sell services to the private sector. Ambulance services is one of the health care services on the Ministry of Health and Social Services that provides emergency services to all those in need.

Health Workforce The workforce situation in Namibia is above the WHO benchmark of 2.5 health workers per 1000 population. In Namibia there are 3.0 health workers per 1000 population. Specific health worker-population ratios include 1:2,952 for doctors, 1:704 for registered nurses, 1:10,039 for pharmacists, 1:13,519 for social workers, and 1:28,562 for health inspectors, among others. This situation though conceals the fact that there is a very unequal distribution with most health workers concentrated in urban areas and a high percentage found in the private sector in particular in private clinics. Overall 26.9 percent of posts in the public sector are vacant, 36% for doctors, 21% for registered nurses, and 42% for social workers. The country depends very much on the recruitment of expatriate doctors.

Information and research Health information is for management and policy change and development. Information is generated through routine data collection, analysis and reporting. Information systems do also cover human resources, infrastructures and other health resources. Adequately managed systems are essential for any service delivery. The international recommendation is 5% of the health budget if information systems are to function and deliver knowledge and information as required.

The Bamako Call to Action on Research for Health and The Algiers Declaration (2008) both emphasize the urgency of investing more in health research and knowledge generation for advancing national health development. There is a call to aim at spending 2% of the health budget on research activities. It is well recognized that the regular NDHS provide essential health status information and the addition of the first Health and Social Services System Review 2008 is an essential tool for health system review. The regular National Health Account survey adds useful information to the information pool as does the Annual Report on Essential Indicators.

The existing information system suffers from degrees of fragmentation where resource-strong programmes “push” their own information system agenda. The central information system is grossly understaffed. The electronic health information system (HIS) is slow to produce required reports and consequently annual reports have not been issued on a regular basis. There is a problem with the completeness of data with problems of collecting data from the private sector.

Healthcare Technologies All issues pertaining to medicines in Namibia are guided by the National Drug Policy (2010). The legislation controlling medicines and related substances is Act 13 of 2003 that was implemented in August 2008. Under this Act the Namibian Medicines Regulatory Council has been mandated to control medicines and related substances in Namibia. A system of registration of medicines and inspection of manufacturers and facilities where medicines are kept is in place but is hampered by shortage of staff. In the public sector there is a centrally managed system for procurement, storage and distribution of medicines and related supplies and all medicines to be supplied in the public health facilities must first be included in the

Namibia Essential Medicines List (Nemlist). The Nemlist is currently in its fourth edition, printed in December 2008. In addition to specifying which medicines are available in the public health sector the Nemlist also divides medicines into different classes which determine at which level of care they can be available, or for which conditions they may be used. Various efforts have been made to address the critical shortage of trained pharmacy staff in Namibia. The MoHSS has recruited pharmacists using development partner funds to address the critical shortage of staff. Furthermore the intake for Pharmacist’s Assistants Training Course at the National Health Training Centre has been increased from 10 to 25 per year, more Namibians are being sent to study pharmacy in other African countries.

The introduction of the Electronic Dispensing Tool into all main ART sites has also improved the efficiency of pharmacy staff by reducing the time they have to spend on manual record keeping. Improving rational use of medicines has been targeted since the mid 1990s. Relevant health workers have been trained on rational use of medicines, therapeutics committees have been strengthened, three national medicine use surveys have been conducted and a comprehensive Standard Treatment Guideline (STG) for Namibia is due to be launched soon. However, irrational use of medicines remains an area of major concern. The main challenge at central level is that contracted suppliers do not supply on time. At operational level the main constraint experienced is shortage of qualified staff to provide pharmacy services. There are currently no posts in the MoHSS staff establishment for Pharmacists in a District Hospital. Other major constraints at operational level are shortage of appropriate space for providing pharmacy services, inappropriate use of medicines, and poor stock management.

Health financing: Namibia is upper middle-income country with a very unequal distribution of wealth. Health inequalities are embedded in such wealth inequalities. The per capita spending on health is (1264 N$, 2005) comparing favorably with countries in the region. Health care financing in Namibia is mainly tax-based. Health care spending as a percentage as of total government spending is 13.5% - the highest in the region, but still short of the Abuja target of 15%. User charges (registration fee) in the public sector are in place as an instrument to discourage people to go directly to hospitals. International partners, although few, provide a substantial contribution targeting special programmes. Their contribution was 23% in 2007. Donor funds are included in forward public sector budgeting, but do not appear in the annual budget announcement by the MoF.

The private sector contribution is 25%. Faith based organizations receive grants from MOHSS for provision of health services according to agreed contractual arrangements. There is an insurance scheme providing health insurance for public sector employees. Private insurance companies provide health insurance policies for private sector employees. Out-of- pocket payment is at this moment not a sizable percentage according to the latest National Health Account. Planning and budgeting are done in separate entities in the MoHSS and need to be brought together. The MTEF for the health sector requires definition of programmes.

The MoF has introduced an integrated financial management system (IFMS), which has the potential to de-concentrate access to this system but, unexpectedly, it has made it more cumbersome for the regions to access funds as the system is not yet established in the regions. FDC holders (regions and directorates at central MoHSS) control their budget allocations and are the key actors involved in planning and budgeting. The revenue collected in the MoHSS comes mainly from the sale of services (76%) in government hospitals to private patients and providers. All revenue goes into the public coffer in the MoF including user fees. In the hospitals there is no proper billing system in place. Public finances for health are increasingly coming under stress in particular from expenses to special programmes.

Governance : The MoHSS is the sole custodian of the health of the people in the country but not the sole custodian of responses and interventions. For social welfare the responsibility is shared with other ministries: Ministry of Gender Equality and Child Welfare, Ministry of Labour and Social Welfare, and Ministry for Veterans Affairs. Other ministries share responsibility for specific and general interventions for promotion and prevention. The MoHSS ensures universal coverage and access to health care through adequate policies such as emphasis on PHC.

The stewardship function delivers through formulation of policies, national as well as programme policies, planning and budgeting, and establishment of relevant technical programmes providing guidance and support. Facility planning is a central function with some overlapping responsibilities. A strategic plan has been developed for the period 2009 to 2013 with emphasis on service provision, human resource management, infrastructure development and management, financial management and governance as a reflection of the areas under scrutiny in the Health and Social Services System Review. The strategic plan will be an important instrument in providing two cycles of strategic planning in a policy cycle of 10 years.

The MoHSS has been mandated by Cabinet to manage and Coordinate the National response to HIV and AIDS, through the establishment of the National AIDS Coordination Program (NACOP) and the five yearly National Strategic Plans/Frameworks. The MoHSS assures overall sector management including the private sector. It regulates a number of areas with various legal instruments. Such legal instruments need to be updated in particular the Public Health Act (1919). Also the Mental Health Bill needs to be enacted to provide the necessary protection of people with mental health problems, while various other policy and legal instruments need to be completed, updated, developed and/or enacted. The MoHSS enters into contractual arrangements through outsourcing arrangement with Faith-based organizations and other contractual partners. There is a problem with inadequate management of the contracts with service providers.

The independent Health Professionals Council of Namibia is responsible for assuring that all health professionals operating in the country have a recognized formal training. The MoHSS is responsible for defining scope of practice and for providing the requisite institutional and legal protection of its workforce.

Table2. Distribution of population, Village/communities and health facilities in district and regions Total No. of Region/Province Districts Number of health facilities Population villages/communities

Caprivi Katima Mulilo 100,528 Referral District Health Hospitals Hospital Centers Erongo Omaruru 19,415 0 1 4

Erongo Swakopmund 42,590 0 2 1 Erongo Usakos 16,499 0 2 1 Erongo Walvis Bay 54,897 0 2 2

Hardap Aranos 11,337 0 1 1 Hardap Mariental 39,203 0 1 1 Hardap Rehoboth 33,576 0 1 2

Karas Karasburg 19,071 0 1 1 Karas Keetmanshoop 38,465 0 1 2 Karas Luderitz 27,324 0 2 0

Kavango Andara 37,047 0 1 0 Kavango Nankudu 62,471 0 1 4 Kavango Nyangana 34,041 0 1 0

Kavango Rundu 147,680 0 1 3 Khomas Windhoek 316,508 2 5 2 Kunene Khorixas 17,400 0 1 0

Kunene Opuwo 54,768 0 1 2 Kunene Outjo 19,264 0 1 1 Ohangwena Eenhana 84,382 0 1 0

Ohangwena Engela 196,126 0 1 2 Ohangwena Okongo 28,052 0 1 0 Omaheke Gobabis 95,010 0 1 2 Omusati Okahao 35,511 0 1 1 Omusati Oshikuku 124,673 0 1 2

Omusati Outapi 83,320 0 1 3

Omusati Tsandi 45,610 0 1 1 Oshana Oshakati 211,031 0 2 6 Oshikoto Onandjokwe 186,393 0 1 3

Oshikoto Tsumeb 30,465 0 2 0 Otjozondjupa Grootfontein 51,256 0 2 1 Otjozondjupa Okahandja 35,527 0 1 0

Otjozondjupa Okakarara 29,411 0 1 0 Otjozondjupa Otjiwarongo 73,799 0 2 2

1.3 NDT Situation analysis

1.3.1 Epidemiology and Burden of disease

This section provides the current known status of NTDs endemicity and current control interventions for the common neglected tropical diseases in Namibia. Activity plans have been put in place to finalize areas that still need baseline information for the diseases that are reported here.

Schistosomiasis and Soil Transmitted Helminthes,

Schistosomiasis and soil-transmitted helminthes (STH) are believed to be endemic in Namibia. The WHO estimates that all Namibia children are at risk for STH (i.e. 750,000) and that 275,000 children are at risk for schistosomiasis. However, recent data, graphically depicted in the map below from the Global Atlas of Helminthes Infections (GAHI), depict that endemicity may be more localized. Data from the Namibian Government states that approximately 200,000 (about 11-14%) of all Namibians were infected with schistosomiasis in 1999.1 The majority of infections (Schistosoma spp. and STH) are believed to occur mainly in Oshana, Omusati, Kavango and Caprivi, mainly due to population density and climatic conditions. Schistosomiasis did not exist in Omusati and Oshana before the Olushandja Dam and the canals were built in the 1970s.

These estimates are based on few epidemiological surveys and not based on accurate and systematically gathered data. Therefore, there is still a need for Mapping; i.e. to gather baseline epidemiological.

Although Namibia is a dry country, seasonal flooding in the north of the country has become an annual event.

This not only leads to closure of schools for extended periods, but affects hygiene conditions at schools and hostels. Therefore in order to estimate more accurate prevalence of Schistosomiasis and Soil Transmitted helminthes and provide the appropriate preventive chemotherapy according with WHO algorithm, the ministry with financial and technical support from the ENDFUND embarked on a phased approach mapping. The aim was to identify communities at risk of the disease and ensure that available resources are targeted to treat all affected communities while excluding non-endemic communities where treatment is not required.

Methodology

Design of mapping Due to the country’s large size, sparsely located population and since this is a new type of activity by the Government, mapping of Namibia should be conducted in four phases. These phases have been established according to epidemiological and demographic data in order to maximize cost-effectiveness (see Figure 1 below):

Phase 1 – Caprivi and Kavango regions Phase 2 – Omusati, Oshana, Oshikoto and Ohangwena regions Phase 3 – Kunene, Otjozondjupa and Khomas regions Phase 4 – Erongo, Omaheke, Hardap and Karas regions

Figure 1 – Map of Namibia’s governmental regions, mapping phases and hydrographic details

Sample size justification

Schistosomiasis and STH infections have different distribution characteristics; while schistosomiasis transmission depends on the presence of two hosts and water (meaning transmission is more focal), transmission of STH infections is far less restricted, meaning it is more homogeneously distributed along a map. Therefore, mapping approaches and “resolutions” must differ to accurately identify the distribution of both diseases.

STH mapping Namibia has eight ecological zones, namely: Central plateau, Damaraland landscapes, Ekuma plains and Etosha pan, Escarpment, Kalahari sands plateau, Kalkveld, Kaokoland landscapes, Namib sand seas and desert plains. Of these, only one falls exists in the Caprivi and Kavango regions (the Kalahari sands plateau). According to WHO recommendations, surveying 5 to 10 schools per ecological zone is sufficient, resulting in a sample size varying between 40 and 80 schools country-wide mapped for STH infections. Our sample will be 75 schools (30 children aged 10-14 years per school), which is a conservative approach.

Schistosomiasis mapping Under the assumption that the population of school-attending school-aged children was 408,804 in 2011, we estimate that the target population in 2012 will be 1.8% larger (i.e. 416,162 children attending schools). The expected frequency of schistosomiasis in Namibia according to WHO is 11%. This is likely a conservative number as prevalence in school-aged children (whom are at higher risk of infection) and in certain regions (northern regions) will be higher. We estimated that a total sample size of 10,600 school-aged children (both sexes) nation-wide is required for a precision of ±5% with a confidence level of 99.9%, and design effect of 2.5. Sample size calculation was corrected for a cluster design assuming the existence of 1497 clusters. Computations conducted using Epi Info v. 7.1.0.6 (CDC, Atlanta, USA).

Sampling method

According to data from the MoE, there are a total of 1497 schools for primary level, with 408804 students enrolled nation-wide (2011 census data). Due to the low population density of Namibia and non-normal distribution along its regions, we have opted for a sampling method that is representative of population density. I.e. the number of schools per region and constituency will not be equal for all but a proportion of the total available. Other mapping initiatives in Africa have used a different approach, whereby a given number of schools is selected per district independent of population density. This would not be applicable to Namibia as many constituencies would not have enough schools (or population).

Therefore, and to ease field-applicability of the sample size calculated (10,600 children), we have opted to sample 30 children (10-14 years of age) per school in 374 schools (of the 1497 available), giving us an actual sample size target of 11,220 children.

Mapping of schistosomiasis will largely be conducted through a rapid mapping approach. This means that rapid diagnostic tests will replace common microscopy methodologies, therefore speeding up the process for a much lower cost. Mapping of STH will still rely on microscopy since no rapid diagnostic tests are available. In

14 schools where a microscopy team is deployed, schistosomiasis diagnosis will be confirmed by normal microscopy methodologies, therefore allowing to estimate diagnostic performance of rapid diagnostic tests. So, in more detail:

Rapid (R) mapping Our “mapping resolution” will be 1 in every 4 schools available in the regions. Schistosomiasis diagnosis will be conducted by rapid diagnostic tests only. No diagnosis of STH infections. Meaning 374 schools will be mapped using rapid diagnostic tests for intestinal (circulating cathodic antigen, or CCA test) and urogenital schistosomiasis (microhaematuria as measure by the Hemastix test) Microscopy + Rapid (M+R) mapping Our “mapping resolution” will be 1 in every 20 schools. Of the 374 schools indicated above, 75 will be mapped using a microscopy team by standard microscopy to detect STH infections and schistosomiasis along with the rapid diagnostic tests for schistosomiasis (as above).

Early and Late-primary students

As demanded by the funding body, this initial map should serve as a good baseline map against which future monitoring and surveillance activities can be judged. For this reason, and given new findings that preschool-aged children are at risk of schistosomiasis and STH infections, we decided to investigate the prevalence of these diseases upon school entry (first grade) as a proxy for disease dynamics in preschool- aged children.

Table 3A. Prevalence of schistosomiasis by constituency (Addd year) Region Constituency Prevalence (%) Study method Year of survey and reference Caprivi Kabe 26 Urine filtration, CCA, Haematuria Mapping Report Caprivi Katima Mulilo Rural 7 Urine filtration, CCA, Haematuria Mapping Report Caprivi Katima Mulilo Urban 14 Urine filtration, CCA, Haematuria Mapping Report Caprivi Kongola 48 Urine filtration, CCA, Haematuria Mapping Report Caprivi Linyanti 18 Urine filtration, CCA, Haematuria Mapping Report Caprivi Sibinda 9 Urine filtration, CCA, Haematuria Mapping Report Kavango Kahenge 22 Urine filtration, CCA, Haematuria Mapping Report Kavango Kapako 23 Urine filtration, CCA, Haematuria Mapping Report Kavango Mashare 16 Urine filtration, CCA, Haematuria Mapping Report Kavango Mpungu 22 Urine filtration, CCA, Haematuria Mapping Report Kavango Mukwe 13 Urine filtration, CCA, Haematuria Mapping Report Kavango Ndiyona 13 Urine filtration, CCA, Haematuria Mapping Report Kavango Rundu Rural East 13 Urine filtration, CCA, Haematuria Mapping Report Kavango Rundu Rural West 7 Urine filtration, CCA, Haematuria Mapping Report Kavango Rundu Urban 28 Urine filtration, CCA, Haematuria Mapping Report Ohangwena Eenhana 5.3 Urine filtration, CCA, Haematuria Mapping Report Ohangwena Endola 6.3 Urine filtration, CCA, Haematuria Mapping Report Ohangwena Engela 4 Urine filtration, CCA, Haematuria Mapping Report Ohangwena Epembe 2.5 Urine filtration, CCA, Haematuria Mapping Report Ohangwena Ohangwena 3.3 Urine filtration, CCA, Haematuria Mapping Report Ohangwena Okongo 2.6 Urine filtration, CCA, Haematuria Mapping Report Ohangwena Omundaungilo 1.7 Urine filtration, CCA, Haematuria Mapping Report Ohangwena Omulonga 6.9 Urine filtration, CCA, Haematuria Mapping Report Ohangwena Ondombe 4.5 Urine filtration, CCA, Haematuria Mapping Report Ohangwena Ongenga 5.6 Urine filtration, CCA, Haematuria Mapping Report Ohangwena Oshikango 1.7 Urine filtration, CCA, Haematuria Mapping Report Omusati Anamulenge 4.6 Urine filtration, CCA, Haematuria Mapping Report Omusati Elim 6.7 Urine filtration, CCA, Haematuria Mapping Report Omusati Etayi 2.9 Urine filtration, CCA, Haematuria Mapping Report Omusati Ogongo 7.1 Urine filtration, CCA, Haematuria Mapping Report Omusati Okahao 3.9 Urine filtration, CCA, Haematuria Mapping Report Omusati Okalongo 4.2 Urine filtration, CCA, Haematuria Mapping Report Omusati Onesi 5.8 Urine filtration, CCA, Haematuria Mapping Report Omusati Oshikuku 3.9 Urine filtration, CCA, Haematuria Mapping Report Omusati Otamanzi 5.8 Urine filtration, CCA, Haematuria Mapping Report Omusati Outapi 4.4 Urine filtration, CCA, Haematuria Mapping Report Omusati Ruacana 7.7 Urine filtration, CCA, Haematuria Mapping Report Omusati Tsandi 5.7 Urine filtration, CCA, Haematuria Mapping Report Oshana Okaku 4.4 Urine filtration, CCA, Haematuria Mapping Report Oshana Okatana 4.6 Urine filtration, CCA, Haematuria Mapping Report Oshana Okatjali 5 Urine filtration, CCA, Haematuria Mapping Report Oshana Ompundja 5.6 Urine filtration, CCA, Haematuria Mapping Report Oshana Ondangwa 9.7 Urine filtration, CCA, Haematuria Mapping Report Oshana Ongwediva 11.7 Urine filtration, CCA, Haematuria Mapping Report Oshana Oshakati East 8.9 Urine filtration, CCA, Haematuria Mapping Report Oshana Oshakati West 2.5 Urine filtration, CCA, Haematuria Mapping Report Oshana Uukwiyu 1.7 Urine filtration, CCA, Haematuria Mapping Report Oshikoto Eengodi 1.3 Urine filtration, CCA, Haematuria Mapping Report Oshikoto Guinas 11.7 Urine filtration, CCA, Haematuria Mapping Report Oshikoto Okankolo 2.9 Urine filtration, CCA, Haematuria Mapping Report Oshikoto Olukonda 2.8 Urine filtration, CCA, Haematuria Mapping Report Oshikoto Omuntele 1.4 Urine filtration, CCA, Haematuria Mapping Report Oshikoto Omuthiyagwiipundi 4.4 Urine filtration, CCA, Haematuria Mapping Report Oshikoto Onayena 3.7 Urine filtration, CCA, Haematuria Mapping Report Oshikoto Oniipa 3 Urine filtration, CCA, Haematuria Mapping Report Oshikoto Onyaanya 4 Urine filtration, CCA, Haematuria Mapping Report Oshikoto Tsumeb 4.4 Urine filtration, CCA, Haematuria Mapping Report

Table 3B. Prevalence of Soil Transmitted Helminthes (STH) by constituency Region Constituency Prevalence (%) Study Year of survey and method reference Caprivi Kabe 3 Microscopy Mapping Report Caprivi Katima Mulilo Rural 0 Microscopy Mapping Report Caprivi Kongola 10 Microscopy Mapping Report Caprivi Linyanti 3 Microscopy Mapping Report Caprivi Sibinda 2 Microscopy Mapping Report Kavango Kahenge 42 Microscopy Mapping Report Kavango Kapako 12 Microscopy Mapping Report Kavango Mashare 16 Microscopy Mapping Report Kavango Mpungu 64 Microscopy Mapping Report Kavango Mukwe 17 Microscopy Mapping Report Kavango Ndiyona 25 Microscopy Mapping Report Kavango Rundu Rural East 13 Microscopy Mapping Report Ohangwena Eenhana 40 Microscopy Mapping Report Ohangwena Engela 3.3 Microscopy Mapping Report Ohangwena Epembe 10 Microscopy Mapping Report Ohangwena Ohangwena 11.7 Microscopy Mapping Report Ohangwena Okongo 11.1 Microscopy Mapping Report Ohangwena Omundaungilo 55 Microscopy Mapping Report Ohangwena Omulonga 20 Microscopy Mapping Report Ohangwena Ondombe 1.7 Microscopy Mapping Report Ohangwena Ongenga 0 Microscopy Mapping Report Ohangwena Oshikango 25 Microscopy Mapping Report Omusati Anamulenge 0 Microscopy Mapping Report Omusati Elim 1.7 Microscopy Mapping Report Omusati Etayi 3.3 Microscopy Mapping Report Omusati Ogongo 0 Microscopy Mapping Report Omusati Okahao 6.7 Microscopy Mapping Report Omusati Okalongo 0 Microscopy Mapping Report Omusati Onesi 5 Microscopy Mapping Report Omusati Oshikuku 5 Microscopy Mapping Report Omusati Otamanzi 5 Microscopy Mapping Report Omusati Outapi 1.7 Microscopy Mapping Report Omusati Ruacana 0 Microscopy Mapping Report Omusati Tsandi 0 Microscopy Mapping Report Oshana Okaku 0 Microscopy Mapping Report Oshana Okatana 0 Microscopy Mapping Report Oshana Ondangwa 10.2 Microscopy Mapping Report Oshana Ongwediva 8.3 Microscopy Mapping Report Oshana Oshakati East 0 Microscopy Mapping Report Oshana Uukwiyu 10 Microscopy Mapping Report Oshikoto Eengodi 10 Microscopy Mapping Report Oshikoto Okankolo 6.7 Microscopy Mapping Report Oshikoto Olukonda 0 Microscopy Mapping Report Oshikoto Omuntele 8.3 Microscopy Mapping Report Oshikoto Omuthiyagwiipundi 3.3 Microscopy Mapping Report Oshikoto Oniipa 0 Microscopy Mapping Report Oshikoto Onyaanya 16.7 Microscopy Mapping Report Oshikoto Tsumeb 3.3 Microscopy Mapping Report

Table 4 District Preventive Chemotherapy Diseases Case management diseases

SCHISTO STH TRACOMA Leprosy

Katima Mulilo + + M _ Omaruru M M M _ Swakopmund M M M _

Usakos M M M _ Walvis Bay M M M _ Aranos M M M _

Mariental M M M _ Rehoboth M M M _ Karasburg M M M _

Keetmanshoop M M M _ Luderitz M M M _ Andara + + M _

Nankudu + + M _ Nyangana + + M _ Rundu + + M +

Windhoek M M M _ Khorixas M M M _ Opuwo M M M _

Outjo M M M _ Eenhana + + M _ Engela + + M _

Okongo + + M _ Gobabis M M M _ Okahao + + M _

Oshikuku + + M _ Outapi + + M _ Tsandi + + M _

Oshakati + + M _ Onandjokwe + + M _ Tsumeb + + M _

Grootfontein M M M _ Okahandja M M M _ Okakarara M M M _

Otjiwarongo M M M _

Table 5. Endemic NTD No. of districts suspected No. of districts mapped or No. of districts remaining to be to be endemic known endemicity status mapped or assessed for endemicity status

Schistosomiasis 34 19 15 Soil Transmitted Helminthes 34 19 15

HAT 0 0 0

TRACHOMA

Trachoma is believed to be endemic in some of the regions in Namibia, with the highest levels of endemicity in the north west and north east of the country. No mapping done…….

1.3.2 NDT Programme implementation

The major diseases requiring preventive chemotherapy in Namibia include: Schistosomiasis, Soil Transmitted Helminthes and Trachoma. Schistosomiasis is highly focalized while STH is distributed homogeneously. The prevalence and distribution of trachoma need to be mapped for proper planning and resource allocation

Interventions for Preventive Chemotherapy

NDT programmes in Namibia are co-implemented with other public health programmes such as Mother and Child Health days and National Immunization Days (NID), recently replaced by African Vaccination Week. Although these programmes mainly target children under the age of five and women of child bearing age, school going children (7-15 yrs) benefited intermittently with the last campaign completed in …….(2012). These programmes targeted STHs and nothing added for schistosomiasis and trachoma. Mass preventive chemotherapy for schistosomiasis was last done in 1990.. in selected districts of Omusati, Zambezi, Kavango East and West regions.

Table 6…Summaries of interventions, information on existing PCT programmes NDT Date Total No of Total No (%) Key Key programme District district Population covered strategies partners started targeted covered in targeted used district Schistosomiasis 2012 15 5 MDA, END FUND Health Education STH 2012 15 5 MDA, END FUND Health Education Tracoma No 0 0 0 0 0 0 programme

Interventions for Case management

The Namibia Standard Treatment Guidelines indicate Albendazole as the current drug of choice for STH and Praziquantel for the treatment of schistosomiasis. These drugs are registered in Namibia. These drugs are registered in Namibia and are available at all level of health care were incidences are well taken care of. Mass Preventive Chemotherapy was initiated in 2014 following phased mapping of regions for schistosomiasis and STHs.

Table 7…Summaries of interventions, information on existing CM programme

NDT Date Total No of No (%) Key Key programme District district covered strategies partners started targeted covered used Schistosomiasis STH Tracoma

1.3.3 Gaps and priorities 1.3.4 The table below gives a detailed SWOT analysis of the national NTD programme.

Strengths Weaknesses Strengths Opportunities Threats Opportunities counteracting counteracting weaknesses threats

1.Existence of an NTD 1.Inadequate 1.Major GRN 1. Development 1. Sustainability International steering committee staffing at all levels Restructuring in partner support (UN of Funding support progress agencies, ENDFUND) toward 2.Generic 2. Lack of NDTs elimination of 2.Lack of policies guidelines and UN 2. International focal persons NDTs and guidelines on agencies meetings and at region and NTDs. Technical conferences for district level GRN support. sharing practical contribution 3.NDTs integrated in 3.HIS review in solutions and 3. Poor and different other progress to experiences. surveillance commitment Public Health include data of NDTs toward programmes. indicators for 3. Advocacy with control and NDTs Parliamentary 4. Stakeholders elimination of 4.No budget line Committee on Health commitment NDTs 2.Existence of political will specific for NDTs (NAFINA) towards prevention and 5. management of NTDs 5.Poor / inadequate 4. Academic stakeholder / institutions (UNAM, partners Polytechnic) and local coordination laboratories (NIP) 6.Lack of IEC materials 5. Implementation of 3.Availability of funds 7.No historical data WASH project by from GRN and funding on trachoma stakeholders. partners (ENDFUND) 8.STH data collection not included in the 4. Availability of free PC HIS drugs

PART 2: NTD STRATEGIC AGENDA The Master Plan for Neglected Tropical Diseases in Namibia 2015 – 2020 is aligned to the Regional Strategy on NDTs in the African region 2014 – 2020 and aims to call into action the World Health Assembly resolution to eliminate NDTs.

2.1 Overall NTD Program Mission and Goals

Goal Accelerate the reduction of the targeted NDTs disease burden through prevention, control and elimination by 2020

Vision Namibia free of Neglected tropical diseases

Mission: To initiate and sustain integrated NTD elimination and / or control measure in all endemic districts in Namibia. . 2.2 Guiding Principles and Strategic Priorities

The Namibia NTD Master Plan was developed through a joint collaboration between the Government of Namibia (National, Regional and District level), the Development partners and other stakeholders who critically worked using the relevant national documents resulting in a successful completion of the Master Plan for the National NTD Programme.

The control of NTDs will be managed in accordance with the four strategic priorities as outlined in the table below:

Table 8: Strategic framework Summary STRATEGIC PRIORITIES STRATEGIC OBJECTIVES  Strengthen coordination mechanisms for the NTD control at national, regional Strengthen Government Ownership, and district levels Advocacy, Coordination and Partnership  Strengthen partnerships for NTDs at all levels.  Enhance NTD programme performance reviews and use for decision making  Strengthen advocacy, visibility and profile of NTD control programmes  Support regions and districts to develop integrated annual plans for NTD control Enhance planning for results, Resource  Enhance resource mobilization approaches and strategies at regional, national mobilization and Financial sustainability . and district levels  Strengthen the integration and linkages of NTD programme and financial plans into sector-wide and national budgetary and financing mechanisms  Develop and update national NTD policies and elaborate guidelines and tools  Scale up integrated preventive chemotherapy packages Scale up access to interventions, treatment  Scale up integrated case-management-based diseases interventions, especially and system capacity building for schistosomiasis, STH and Tracoma.  Strengthening integrated vector management for targeted NTDs  Strengthen capacity for NTD programme management and implementation & accelerate disease burden assessments and integrated mapping of NTDs

 Enhance monitoring of national NTD programme performance and outcome Enhance NTD monitoring and evaluation,  Strengthen surveillance of NTDs. surveillance and operational research  Support operational research, documentation and evidence  Establish integrated data management system and support impact analysis for NTD.

PART THREE: OPERATIONAL FRAME WORK This section will describe the implementation of the planed activities. Various diseases has specific focus goals, objectives and strategies. We foresee integration as the most cost effective approach to minimize the limited resources available in our country. Error! Reference source not found. below provides a summary of disease specific goals, objectives, Strategies, national targets, and indicators for the targeted NTDs. Contents of this table have been used to guide activity implementation in the subsequent sections.

NDTs in Namibia include Schistosomiasis, STH and Trachoma. Schistosomiasis is highly focalised and affects the northern regions were men made canals and perennial rivers are present. STHs are homogeneously distributed in northern and central parts of Namibia. The burden of Trachoma is not well documented, but cases have been reported in Kavango and Zambezi regions.

3.1 National NDT Programme goals, objectives, strategies and targets

Table 9 Program Summary components of Strategies for control endemic NTDs PROGRAMME NATIONAL GOALS OBJECTIVES INTERVENTIONS DELIVERY TARGET AND GLOBAL CHANNELS POPULA GOAL TION (at Risk) Schistosomiasis To eliminate 1. To treat all school age children and 1. School and Community 1.5 mil schistosomiasis as high risk population regularly in all community (High risk and School Eliminate public health endemic areas population) based Mass based Schistosomiasis problem by 2025 1. 2. Increase awareness on Preventive by 2025 schistosomiasis prevention and Chemotherapy control 2. Health Education 2. 2. Complete mapping of 3. Conduct mapping in schistosomiasis and establish sentinel the remaining 7 sites for morbidity monitoring regions 4. Improve access to save drinking water and sanitation 5. Monitoring and Evaluation 6.Implement WASH

STH To eliminate soil 1. To treat all school age children and 1. School and Community 1.5 mil To reach at least transmitted high risk population regularly in all community (High risk and School 75% of school- Helminthes as endemic areas population) based Mass based age children at 3. 2. Increase awareness on STH Preventive public health risk of soil- prevention and control Chemotherapy transmitted problem by 2020 4. 2. Complete mapping of STH and 2. Health Education helminthiasis establish sentinel sites for morbidity 3. Conduct mapping in with monitoring the remaining 7 anthelminthic regions treatment by 4. Improve access to 2020 save drinking water and sanitation 5. Monitoring and Evaluation 6. Implement WASH?

PROGRAMME NATIONAL GOALS OBJECTIVES INTERVENTIONS DELIVERY TARGET AND GLOBAL CHANNELS POPULA GOAL TION (at Risk) Trachoma To eliminate 1. map trachoma 1. Conduct mapping / Community ? Elimination of trachoma as 2. Increase awareness Survey based, blinding blinding disease by 3. 3. Conduct T T Surgery? 2. Health Education facility trachoma by 3. Conduct T T Surgery? based 2025 2020 as a public 4. MDA (Zinthromax) health problem

Table 9.2: PROGRAMME OBJECTIVES AND KEY INDICATORS OF PERFOMANCE NTD Programme Objective Key Indictor Baseline Target Milestones

2015 2016 2017 2018 2019

Schistosomiasis 1. To treat all Geographical 100% 80% 100% 100% 100% school age coverage in SCH 100% To eliminate children and endemic district schistosomiasis as high risk (Proportion of public health population targeted districts problem by 2025 regularly in all Treated) endemic areas 5.

STH 1. To treat all Geographical 100% 80% 100% 100% 100% 100% school age coverage in SCH To eliminate soil children and endemic district transmitted high risk (Proportion of Helminthes as population targeted districts public health regularly in all Treated) problem by 2020 endemic areas 6. TRACHOMA 1.Conduct Prevalence ? ? ? ? ? ? ? To eliminate Surveillance of trachoma as trachoma blinding disease by 2025

3.2 Strengthen government ownership, advocacy, coordination and partnership

Table 1: Strategic Priority 1: Strengthen government ownership, advocacy, coordination and partnership

Details Activity Timeframe Resources needed (Sub-activities)

Strategic Objective 1: Strengthen coordination mechanism for the NTD control programme at national, regional and District level.

Set up and strengthen the Coordination systems for the Establish a NDT TWG (Include stake holders) Office space, personnel MOHSS, NTD Units at National. Regional and District levels Establish focal points at National, Region and District levels 2015 Propose that NAFIN serves as steering committee??? Prepare TORs for the steering committee Conduct meeting s to guide establishment of Venue, personnel, transport, stationery, coordination mechanisms at regional and District levels 2015 refreshments

Establish and conduct NTD secretariat meetings Conduct NTD Monthly Secretariat meetings at National Refreshments level Monthly 2015- 2019

Conduct Advocacy sessions for involvement of more Venue, media, personnel, transport, partners in NTD control at different levels Bi annually, 2015-2019 stationery, refreshments

Strategic Objective 2: Strengthen and foster partnerships for the control, elimination and eradication of targeted NTDs at national, district and community levels. Strengthen Country Partnership in NTD control Conduct annual partners and stakeholders meetings Annually : 2015-2019 Conference package, allowances, personnel, transport, stationery, refreshments Disseminate reports and relevant documents to all Tickets, Venue, Allowances, Refreshments partners and stakeholders Biannually 2015-2019 Conduct NTD Steering committee annual meetings Venue, personnel, transport, stationary, Biannually refreshment, allowance Strategic Objective 3: Enhance high level reviews of NTD programme performance and the use of lessons learnt to enhance advocacy, awareness and effective implementation. Venue, personnel, transport, stationery, Conduct NTD steering committee bi annual meetings Biannually refreshments, allowance Venue, personnel, transport, stationery, Conduct program Review Meetings at all levels Annually 2015-2019 refreshments, allowance Take part in high level policy/decision making meetings at Senior MOHSS management meeting Adhoc 2015 - 2019

Details Activity Timeframe Resources needed (Sub-activities) national and international fora Participate in international fora, e.g. GAELF meetings, ITI, Travel expenses, conference reg. fees, Annualy 2015 - 2019 Global health meetings, NTD TEC, etc. Strategic Objective 4: Strengthen IEC and BCC, visibility and profile of NTD control elimination and eradication interventions at all levels. Strengthen IEC and BCC fora for the NTD programme Develop and implement appropriate integrated NTDs Venue, personnel, transport, stationery, 2016 communication strategy refreshments, allowance, Consultancy Personnel, transport, stationery, Conduct KAP studies on integrated NTD at various levels 2017 refreshments/conference package, allowance, FGD-tape recorders, Video Cameras Production and distribution of IEC material 2016 In-house, allowances, Consultancy-for high level, Venue, personnel, Conduct sensitization and social mobilization meetings for 2015-2019 transport, stationery, refreshments, MDA allowance, Conduct IEC & BCC Activities for the NTD Programme Conduct mass media campaign to raise awareness and Air time, IECs, stationery, Video tapes, sensitization (radio programs, documentary, TV, print 2015-2019 consultancies, Printing media and social marketing) IECs, Fuel, personnel, Commemoration National NTD day- Annually, 2015-2019 Entertainment, Chairs, tents consultancy, Refreshments, Conduct School NTD competition Every NTD Day Prize money, certificates, Preparation of radio/TV programmes on NTDs for public Refreshments, Funds, personnel, air time, 2011-2019 health education venue, Community Sensitization and Mobilization on NTD control Launching of NTD National Strategic Plan 2015 - 20120 IECs, Fuel, personnel, and elimination 2016 Entertainment, Refreshments, Development, Production and dissemination of integrated Conference package, Printing, funds, NTD IEC materials 2015-2019 transport, allowances Organize and participate in various Exhibitions Exhibition posts, Personnel, Transport, Fuel, 2015-2019 printing